Higher Adult Weight Research Articles

Birth weight and birth length affect future fracture risk differently in men and women

SummaryWe wanted to determine if there are any associations between birth factors and adult fracture risk. For women only, shorter birth length was associated with lower relative fracture risk. For women and men, individuals who were long at birth as well as tall in adulthood had a substantially higher relative fracture risk.PurposeWe aimed to examine associations between birth anthropometry and adult fracture risk and to investigate if developmental mismatch is associated with fracture risk.MethodsWe included 4635 participants (476 women and 4159 men; born 1921–1950) with hospital and national registry-based data on birth anthropometry and adult fractures (≥ 50 years). We tested associations by Cox proportional hazards regressions and present hazard ratios (HR) with 95% confidence intervals.ResultsIn total, 1215 (26%) suffered ≥ 1 fracture during a mean observation period of 26 years. In women, unadjusted analyses indicated that both higher birth weight (HR 1.42 per kg (1.10–1.84)) and birth length (1.10 per cm (1.05–1.17)) were associated to higher adult fracture risk. After adjustment (year of birth and gestational age), statistical significance remained only for birth length, HR 1.10 per cm (1.04–1.17). For men, no associations were apparent. We found no associations between developmental mismatch (lower birth weight followed by higher adult weight) and adult fracture risk. However, for both sexes, being born tall and staying tall into adulthood was associated with a markedly higher (55–105%) relative fracture risk (HR women 2.09 (1.18–3.68), men 1.55 (1.19–2.03)) compared to being born short and remaining short in adulthood.ConclusionIn this study, being born shorter and lighter was associated with a lower risk for fractures ≥ 50 years in women. However, analyses indicated that tall adults who were also long at birth may be at markedly higher risk of fractures; this warrants further examinations.

Biological characteristics of the egg-larval parasitoid Chelonus oculator (Fabricius, 1775) (Hymenoptera: Braconidae) on the potato tuber moth Phthorimaea operculella (Zeller, 1873) (Lepidoptera: Gelechiidae) at different temperatures

This study was conducted to determine some biological properties of the potato tuber moth Phthorimaea operculella, a new host of the egg-larval parasitoid Chelonus oculator at different temperatures. The emergence rate, development time, longevity, adult weight, and sex ratio of C. oculator were assessed at three different temperature levels (20±1 ºC, 25±1 ºC, 30±1 ºC), 65±5% humidity and 16:8 light: dark conditions. Forty potato tuber moth eggs, aged 0-24 hours, adhered to the filter papers, were placed into the tubes, and presented to the parasitoids for parasitization for a day. At the end of this period, the parasitized eggs were allowed to develop at the specified temperatures. The study found the highest emergence rate was found at 30 °C, with 20.5%. The longest development period occurred at 20 °C, determined as 49.00±2.00 days in females and 52.27±1.64 days in males. The longest longevity of the parasitoid was found to be 41.71±2.29 and 45.73±3.75 days in males and females, respectively. The highest adult weight was observed at 25 °C for both males and females. The sex ratio was found to be in favor of males as the temperature decreased. It is thought that these results can be used for the biological control of potato tuber moth in the field and storage conditions for release studies.

Growth and growth curve analysis in Dorper × Tumele crossbred sheep under a smallholder management system

This study aimed to evaluate the growth performance and Kleiber ratio (KR) and to determine the growth curve of Dorper × Tumele sheep under a smallholder management system. Growth and efficiency-related traits were analyzed by using the general linear model (GLM) procedure of SAS. Gompertz, Logistics, Brody, Monomolecular, and Negative exponential models were used to determine the growth curve, and growth curve parameters were estimated via the nonlinear regression model (NLIN) procedure of SAS. The overall least-squares means of the birth weight, weaning weight, 6-month weight, and yearling weight were 3.29, 13.7, 17.3, and 23.4 kg, respectively. Dorper × Tumele lambs grew faster during the preweaning period (115.3 ± 1.19 g day-1) than during the postweaning periods (44.1 ± 1.26 g day-1 to 33.5 ± 1.13 g day-1). Likewise, a higher KR was observed during the pre-weaning age (16.1 ± 0.08 g/day/kg0.75) than during postweaning periods (5.08 ± 0.13 g/day/kg0.75 to 3.10 ± 0.09 g/day/kg0.75). Brody, a model without an inflection point was the best-fitted growth function for Dorper × Tumele sheep under a smallholder management system. The highest and lowest asymptotic weight was observed for Brody (23.8 ± 0.22 kg) and Logistics (20.7 ± 0.11 kg) models, respectively. The maturation rate ranged between 0.21 (Brody) and 0.66 (Logistics). Based on the Brody model, the correlation between asymptotic weight and maturity rate was -0.92. The growth parameter estimate in this study indicates that Dorper × indigenous sheep had a better speed to achieve mature weight and the early mature crossbred sheep are less likely to exhibit high adult weight. The rapid growth of crossbred sheep during the early period can provide more profit to the farmer by reducing the cost of sheep production inputs. Therefore, crossing Tumele with Dorper sheep and integrating with improved management would be suggested to improve productivity and profit from sheep production.

Behavioral, cognitive, and socioemotional pathways from early childhood adversity to BMI: Evidence from two prospective, longitudinal studies.

Childhood adversity is associated with higher adult weight, but few investigations prospectively test mechanisms accounting for this association. Using two socioeconomically high-risk prospective longitudinal investigations, the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA; N = 267; 45.3% female) and the Fragile Families and Child Wellbeing Study (FFCWS; n = 2,587; 48.5% female), pathways between childhood adversity and later body mass index (BMI) were tested using impulsivity, emotion dysregulation, and overeating as mediators. Childhood adversity from 0 to 5 years included four types of adversities: greater unpredictability, threat/abuse, deprivation/neglect, and low socioeconomic status. Parents reported on child impulsivity, emotion dysregulation, and overeating. Height and weight were self-reported and measured at 32 and 37 years in MLSRA and at 15 years in FFCWS. FFCWS results indicated that threat, deprivation, and low socioeconomic status predicted greater impulsivity and emotion dysregulation at 5 years, which in turn predicted greater overeating at 9 years and higher BMI z-score at 15 years. Early unpredictability in FFCWS predicted higher BMI through greater impulsivity but not emotion dysregulation at age 5. MLSRA regression results replicated the threat/abuse → emotion dysregulation → overeating → higher BMI pathway. These findings suggest that different dimensions of early adversity may follow both similar and unique pathways to predict BMI.

Kleiber ratios and growth curves of African Black and Red Neck ostrich breeds and their crossbreeds

The selection of animals with lower production costs can be achieved by using feed efficiency and growth curve information. Kleiber ratio (KR) is an alternative option for discriminating against the animals that have the greatest weight gain about their final weight. Alternative feed efficiency and growth curves for ostriches of the African Black (AB) and Red Neck (RN) breeds and their crossbreeds (CB) were investigated using KR and Gompertz equation. Univariate and multivariate analyses were used. The highest adult weight was identified in the RN and CB. AB was more precocious than the RN and CB individuals. Only AB animals reached 75% of their mature weight at one year of age. At 180 days, AB showed better KR. AB was different from the others, mainly for KR at 90 days and 180 days. Considering multivariate analysis, AB animals were different from the others, regardless of sex, mainly for KR at 90 days and KR at 180 days. Other subgroups separated the animals by sex. In a market preferring animals of minor structure (smaller cuts) and greater precocity, it would be suitable to opt for AB. When animals with greater body structure (larger cuts) are desired, males RN and CR is the best option, however, it will be slaughtered with greater age and lower value for KR (may generate a bigger production cost ). It is possible to obtain animals with precocity and high KR, being well represented by the AB breed.

An analysis of weight loss efforts and expectations in a Canadian Cohort: A retrospective medical chart review.

The weight loss history and weight loss goals were examined in 4108 patients referred to a publicly funded evidence-based clinical weight management program using a retrospective chart review. The majority of patients were white females, aged of 50.1 ± 13.7 years and a BMI of 39.0 ± 7.5 kg/m2 . Pregnancy was the most common reason for weight gain in women (17.7%) and while the reasons in men are more varied (injury, stress and medication: all ~5%). Over 50% of patients cited no specific reason for their weight gain. Self-directed diet and exercise were the most commonly used self-reported weight loss methods. Women were more likely to report using medication and bariatric surgical weight loss methods than men (P < .05), and only 5% of women and 12.8% men report never having tried to lose weight in the past. Patients had an ideal weight loss goal of 28.9% to 34.4%, which was similar to the patient's lowest reported adult weight. Approximately 70% of patients enrolling at the clinic had previously lost at least 4.5 kg (10 lb) one or more times and 16.7% lost weight at least 5 times in their life, but patient weight at enrolment was similar to their highest adult reported weight. Thus, most patients referred to this clinical weight management program have previously attempted self-directed diet and exercise weight loss. Patients were close to their highest adult weight and had very large weight loss goals, similar to what is typically achieved only by surgical intervention, despite having already had several bouts of weight loss.

Compulsive exercise and weight suppression: Associations with eating pathology in distance runners

Some athletes, particularly those who participate in activities that emphasize leanness such as competitive running, are at greater risk for eating disorder (ED) pathology. Compulsive exercise (CE) is linked with ED pathology among female athletes, with evidence that CE for weight control is most strongly correlated with ED thoughts and behaviors. Weight suppression (WS), the discrepancy between highest adult weight and current weight, is also linked with ED symptoms. Taken together, runners with greater WS may be more likely to engage in CE to influence their weight or shape and may subsequently report other associated ED symptoms. As such, the current study investigated associations between CE and ED pathology in a mixed-gender sample of adult distance runners (N = 277, 51% female), and tested the impact of WS on this association. Results indicated that females reported greater CE and ED pathology, whereas males reported greater WS. A significant interaction effect for CE x WS, (p < .05) indicated that the relation between CE and ED scores was stronger among male runners who reported higher WS. In contrast, WS did not impact the association between CE and ED pathology for female runners. Results from the current study have important implications for the assessment and treatment of ED in athletes, specifically runners, and suggest that WS is an important factor to consider when working with male athletes.

Genetic parameter estimates for gastrointestinal nematode parasite resistance and maternal efficiency indicator traits in Santa Inês breed.

Infection with Haemonchus contortus is the most economically important gastrointestinal nematode parasitosis and the most important cause of mortality in sheep production. The aim of this study was to estimate variance components of gastrointestinal parasite resistance traits, maternal efficiency (ME) and ewe adult weight (AW) in Santa Inês breed in tropical conditions. The phenotypic records were collected from 700 animals, belonging to four flocks located south-east and north-east in Brazil. The evaluated traits were as follows: degree of anaemia assessed using the FAMACHA chart (FMC), haematocrit (HCT), white blood cell (WBC), red blood cell (RBC), haemoglobin (HGB), platelets (PLT), faecal egg count (EPGlog ), ME, metabolic maternal efficiency (MME), AW and metabolic ewe adult weight (MAW). From the 700 animals, 576 (82% of the evaluated population) were genotyped with the Ovine SNP12k BeadChip (Illumina, Inc.). Markers with unknown genomic position, located on sex chromosomes, monomorphic, with minor allele frequency <0.05, call rate <90% and with excess heterozygosity were excluded. The variance components were estimated using a single-trait animal model with ssGBLUP procedure. The correlation between the parasite's resistance indicators and the ME suggested that selecting animals with both higher adult weight and ME will also favour the selection of animals with better resistance to gastrointestinal nematodes parasites, specially H.contortus. Therefore, since there are few or no studies with Santa Inês breed in this area, it is important to study those traits to better manage selection programs.

IMPACT OF BODY WEIGHT AT AGE 20 AND WEIGHT GAIN DURING ADULTHOOD ON MIDLIFE CORONARY ARTERY CALCIUM IN 15,000 MEN AND WOMEN: AN INTERIM ANALYSIS OF THE SWEDISH CARDIOPULMONARY BIOIMAGE STUDY

Elevated body weight in adolescence is strongly associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, or to weight gain with subsequent high adult weight is not known. Using data from the Swedish CArdioPulmonary bioImage Study (SCAPIS

Weight suppression and its relation to eating disorder and weight outcomes: a narrative review

ABSTRACTWeight suppression (WS) refers to the discrepancy between highest adult weight and current weight, and has been examined as a key construct related to both: eating pathology and weight management. However, despite increasing interest in WS, findings regarding the clinical implications of WS are often conflicting. For instance, WS has been associated with both adaptive and maladaptive outcomes across various populations. Moreover, results regarding the predictive utility of WS within clinical samples have been inconsistent. The current paper aims to provide a narrative review of existing investigation related to WS, highlight gaps in the field’s understanding of this construct, and outline recommendations for future study.

Multi-male groups positively linked to infant survival and growth in a cooperatively breeding primate

Cooperative breeding is a system where helper individuals care for breeding individuals’ offspring. As a result, social environment is likely to play a key role in regulating reproductive success. In primates, cooperative breeding is only found in the family Callitrichidae. Callitrichid males typically provide more infant care than non-breeding females, and in many callitrichid species, the presence of multiple males has been linked to infant survival. Leontopithecus chrysomelas (the golden-headed lion tamarin) is an endangered callitrichid found in the Atlantic Forest of Brazil. We used long-term data for wild L. chrysomelas to assess the influence of social group composition on reproductive success. Our survival model found that infant survival was negatively associated with group size, but this cost was mitigated by the presence of multiple adult males vs a single adult male. We also found that infants raised in groups with multiple adult males exhibited faster growth rates and higher adult weights than infants raised with a single adult male. This study adds novel evidence for the positive influence of adult males on callitrichid reproduction, demonstrating that adult males influence infant growth, as well as survival, in wild populations of cooperatively breeding primates. We suggest that social group composition, particularly the presence of adult males, be considered in future conservation strategies given its importance for reproductive success. In cooperatively breeding species, group members care for breeding individuals’ offspring. Due to this care, group composition may have a strong influence on infant success. In cooperatively breeding primates, males often provide more infant care than females. We investigated the influence of group composition on infant success in a cooperatively breeding primate, the golden-headed lion tamarin. Using long-term field data, we found that infant survival decreased as group size increased. However, this effect was reduced when multiple adult males were present in the group compared to a single male. We also found that infants grew faster and reached larger adult weights in the presence of multiple adult males compared to a single male. Our results demonstrate the importance of group composition for cooperative breeders and provide new evidence for the positive influence of adult males on cooperatively breeding primate infants.

Considering alternative calculations of weight suppression

Weight suppression (WS)—the difference between an individual's highest adult weight and current weight—relates to eating pathology and weight gain; however, there are several methodological issues associated with its calculation. The current study presents four alternative methods of calculating WS and tests whether these methods differentially relate to maladaptive outcomes. Alternative methods of calculation included: (1) change in BMI units; (2) BMI category change; (3) percent change in weight; and (4) two different uses of regression residuals. A sample of undergraduate students (N=631) completed self-report measures of eating pathology, current and past weight, and teasing. Measures included the Eating Disorder Examination-Questionnaire and the Perceptions of Teasing Scale. Results indicated that components of WS, current weight and highest weight, were strongly related in the present sample. The traditional method of calculating WS was related to eating pathology, binge eating and teasing for both males and females. However, WS indices orthogonal to the highest weight did not correlate with eating pathology and teasing in both males and females; for females, WS indices orthogonal to current weight were also unrelated to eating pathology. Findings suggest that the link between WS and eating pathology is mitigated after accounting for an individual's highest weight. Future research should continue to assess the reliability and clinical utility of this construct and consider using alternative WS calculations.

Abstract 883: Body mass, smoking habit, and hypertension and renal cell cancer survival

Abstract Background: A recent meta-analysis showed higher survival rate among over-weight and obese renal cell cancer (RCC) patients. Given that obesity, smoking and hypertension are well-established risk factors for RCC development, it is therefore important to know whether these factors are associated with RCC prognosis. Objectives: We evaluated the associations of body mass index (BMI), smoking and hypertension with RCC survival in a population-based cohort of incident RCC cases assembled from a Swedish case-control study. Methods: We analyzed a total of 371 RCC cases diagnosed in 1988-1992 with follow-up through Dec 31, 2011. Information on weight, height, smoking habit and hypertension was obtained through face-to-face interviews. Mortality information was determined through linkage to the National Cancer Registry; 298 deaths were identified, with 148 of those having RCC as the underlying cause of death, during an average of 9.9 years of follow-up. We calculated hazard ratios (HR)s and 95% confidence interval (CI)s using the Cox proportional hazards models. Results: We confirmed that lifetime smoking and BMI at highest adult weight were associated with a worse overall survival among RCC patients. When we examined RCC-specific survival, the associations were not statistically significant; multivariate HR (95% CI) was 0.89 (0.54-1.49) for 20 or greater pack-years of smoking compared to never smokers. For BMI at highest adult weight, multivariate HR (95% CI) was 0.99 (0.53-1.87) comparing 35 or greater levels of BMI with less than 27 kg/m2 of BMI. History of hypertension was not associated with overall or RCC-specific survival. Conclusions: We found a decreasing trend of overall survival with increasing prediagnostic BMI and lifetime smoking, but no significant associations of these factors and hypertension with RCC-specific survival among RCC patients. Citation Format: Jung Eun Lee, Nayeon Kim, Hans-Olov Adami, Per Lindblad. Body mass, smoking habit, and hypertension and renal cell cancer survival. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 883. doi:10.1158/1538-7445.AM2015-883

Carcass Traits and Growth Curve Parameters in Santa Inês Sheep

The aim of this study was to evaluate carcass traits and growth curves in Santa Inês sheep. We used weight data collected from 51 developing sheep from birth to 336 days of age, from March 2012 to May 2013. The sheep belonged to the Core Conservation Team of the Federal University of Piauí and were located at two properties, one in Bom Jesus - PI and one in Cristino Castro - PI. The model used to represent the growth curve was the Gompertz model, in which the model parameters were estimated by using a Gauss-Newton algorithm modified by the NLIN procedure in SAS. The rib eye area (REA) and subcutaneous backfat thickness (SBT) of lambs were evaluated by ultrasound. These results were used to study the growth curve and the relationship between the estimated model growth curve parameters and the evaluated carcass traits. The estimated correlation between A and K was negative. The correlations between the carcass traits (REA and SBT) and the growth curve parameters (A and K) show that animals with a high adult weight and a high rate of precocity do not always yield good carcasses. Birth weight is a good indicator of animals that can achieve better weights in adulthood. The management effect influenced the growth pattern of Santa Inês sheep, indicating a need to adapt management decisions. These adaptations would mainly relate to fodder storage during periods of food scarcity, which indirectly relates to climate effects, so there would be no influence on animal growth.

Body size, modifying factors, and postmenopausal breast cancer risk in a multiethnic population: the San Francisco Bay Area Breast Cancer Study.

Data on body size and postmenopausal breast cancer in Hispanic and African American women are inconsistent, possibly due to the influence of modifying factors. We examined associations between adiposity and risk of breast cancer defined by hormone receptor status in a population-based case-control study conducted from 1995–2004 in the San Francisco Bay Area. Multivariate adjusted odds ratios and 95% confidence intervals were calculated using unconditional logistic regression. Associations with body size were limited to women not currently using menopausal hormone therapy (801 cases, 1336 controls). High young-adult body mass index (BMI) was inversely associated with postmenopausal breast cancer risk, regardless of hormone receptor status, whereas high current BMI and high adult weight gain were associated with two-fold increased risk of estrogen receptor and progesterone receptor positive breast cancer, but only in women with a low young-adult BMI (≤22.4 kg/m2) or those with ≥15 years since menopause. Odds ratios were stronger among non-Hispanic Whites than Hispanics and African Americans. Waist circumference and waist-to-height ratio increased breast cancer risk in Hispanics and African Americans only, independent of BMI. These findings emphasize the importance of considering tumor hormone receptor status and other modifying factors in studies of racially/ethnically diverse populations.

Body Mass Index, Exercise, and Other Lifestyle Factors in Relation to Age at Natural Menopause: Analyses From the Breakthrough Generations Study

The authors examined the effect of women's lifestyles on the timing of natural menopause using data from a cross-sectional questionnaire used in the United Kingdom-based Breakthrough Generations Study in 2003-2011. The analyses included 50,678 women (21,511 who had experienced a natural menopause) who were 40-98 years of age at study entry and did not have a history of breast cancer. Cox competing risks proportional hazards models were fitted to examine the relation of age at natural menopause to lifestyle and anthropometric factors. Results were adjusted for age at reporting, smoking status at menopause, parity, and body mass index at age 40 years, as appropriate. All P values were 2-sided. High adult weight (P(trend) < 0.001), high body mass index (P(trend) < 0.001), weight gain between the ages of 20 and 40 years (P(trend) = 0.01), not smoking (P < 0.001), increased alcohol consumption (P(trend) < 0.001), regular strenuous exercise (P < 0.01), and not being a vegetarian (P < 0.001) were associated with older age at menopause. Neither height nor history of an eating disorder was associated with menopausal age. These findings show the importance of lifestyle factors in determining menopausal age.

Weight change and prostate cancer incidence and mortality

The relationship between obesity and prostate cancer risk has been studied extensively but with inconsistent findings, particularly for tumor aggressiveness. Few studies have investigated weight change and prostate cancer incidence or mortality. Using the Melbourne Collaborative Cohort Study, which recruited 17,045 men aged between 40 and 69 years at study entry, we investigated associations between reported weight and body mass index (BMI) at age 18 and measured at study entry, height, weight change between age 18 and study entry and prostate cancer incidence and mortality. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression. During follow-up (mean = 15 years) of 16,514 men, we ascertained 1,374 incident prostate cancers of which 410 were classified as aggressive, and 139 deaths from prostate cancer. The incidence of all prostate cancer was not associated with body size or weight change. Weight and BMI at study entry were positively associated with aggressive prostate cancer risk (HR = 1.06, 95% CI: 1.00-1.13 per 5 kg; HR = 1.27, 95% CI: 1.08-1.49 per 5 kg/m(2)) and prostate cancer mortality (HR = 1.12, 95% CI: 1.01-1.23 per 5 kg; HR = 1.49, 95% CI: 1.11-2.00 per 5 kg/m(2)). Weight gain was positively associated with prostate cancer mortality (HR = 1.13, 95% CI: 1.02-1.26 per 5 kg increment); the HR for ≥ kg weight gain between age 18 and study entry compared to <5 kg gain over this period was 1.84, 95% CI: 1.09-3.09. Higher adult weight and BMI increases the risk of aggressive prostate cancer and mortality from prostate cancer. Weight gain during adult life is associated with increased prostate cancer mortality.

Borderline personality and weight divergence in adulthood

Borderline personality disorder (BPD) is an Axis II dysfunction characterized by extremist thinking (i.e., black/white thinking and thinking in absolutes). In keeping with this cognitive style, and based upon our clinical observations, we wondered whether a possible behavioral marker of extremism, weight divergence (i.e., a large difference between lowest and highest weights in adulthood), might be associated with BPD. Among 95 women psychiatric inpatients, we explored lowest adult weight, current weight, and highest adult weight as well as BPD using two self-report measures for the disorder, the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Results indicated statistically significantly correlations between increasing weight divergence and both BPD measures. Further analyses indicated that this relationship was not explained by overall body size or history of binge eating behavior. Findings suggest that, among psychiatric inpatients, weight divergence in adulthood may be a potential indicator of BPD.

Loss of control over eating is associated with eating disorder psychopathology in a community sample of Latinas

This study examined the association between loss of control and eating disorder psychopathology in a community sample of women of Hispanic origin. Seventy-seven monolingual Spanish-speaking Latinas recruited from the community were administered the Spanish language version of the Eating Disorders Examination (S-EDE). Latinas who reported regular (at least once weekly) loss of control—through objective bulimic episodes (OBEs) and/or subjective bulimic episodes (SBEs)—were compared with Latinas who did not report regular loss of control. Latinas who reported LOC did not differ significantly from Latinas who denied LOC in age, current body mass index, or highest adult weight. Latinas who reported LOC had significantly more frequent weight cycling and significantly higher scores on all S-EDE subscales. The findings suggest that regular loss of control over eating—regardless of the amount of food consumed—may be a marker for the presence of eating disorder psychopathology.

Case Study: A Patient With Diabetes and Weight-Loss Surgery

A.W. is a 65-year-old man with type 2 diabetes who was referred by his primary care physician to the weight center for an evaluation of his obesity and recommendations for treatment options, including weight-loss surgery. The weight center has a team of obesity specialists, including an internist, a registered dietitian (RD), and a psychologist, who perform a comprehensive initial evaluation and make recommendations for obesity treatment. A.W. presented to the weight center team reluctant to consider weight-loss surgery; he is a radiologist and has seen patients who have had complications from bariatric surgery. Pertinent medical history. A.W.'s current medications include 30 and 70 units of NPH insulin before breakfast and before or after dinner, respectively, 850 mg of metformin twice daily, atorvastatin, lisinopril, nifedipine, allopurinol, aspirin, and an over-the-counter vitamin B12 supplement. He has sleep apnea but is not using his continuous positive airway pressure machine. He reports that his morning blood glucose levels are 100–130 mg/dl, his hemoglobin A1c (A1C) level is 6.1%, which is within normal limits, his triglyceride level is 201 mg/dl, and serum insulin is 19 ulU/ml. He weighs 343 lb and is 72 inches tall, giving him a BMI of 46.6 kg/m2. Weight history. A.W. developed obesity as a child and reports having gained weight every decade. He is at his highest adult weight with no indication that medications or medical complications contributed to his obesity. His family history is positive for obesity; his father and one sister are also obese. Dieting history. A.W. has participated in both commercial and medical weight-loss programs but has regained any weight lost within months of discontinuing the programs. He has seen an RD for weight loss in the past and has also participated in a hospital-based, dietitian-led, group weight-loss program in which he lost …